Thick skin for physicians

An attending once told me, “You can’t please ’em all.” And it’s true. Sometimes in medicine, you just have to keep your head up and remember the bigger picture of why you are in this field. A few months ago I did my internal medicine sub-I, which is a rotation medical students take in their fourth year when they are expected to perform on the same level as an intern. I’ve never worked so many hours in my life, but it was one of the most fun, rewarding, and challenging experiences in medical school. During this rotation, I as a medical student was in charge of talking to my patients and their families, explaining medical diagnoses and treatment options and going over their goals of care. I developed great relationships with my patients and I truly began to realize what it means to take ownership over the patients you are responsible for.

One day, a patient’s family member was having a rough time and decided to create an unpleasant scene involving me, the attending, and the nurse, targeting me mainly as the medical student. I remember feeling shocked and hurt because the patient in question and I had a good relationship. The family member had just arrived and interacted with me for less than 10 minutes. I could only listen, nod, and apologize, not wanting to upset anyone further. Afterwards my attending sat me down and told me I had done nothing wrong and not to take anything to heart. She told me that in medicine, you just have to develop thick skin. Even as an attending, patients transfer to other providers, doubt your judgment, second guess your intentions. All you can do is practice good medicine and take care of patients the best you can. You can’t control everything and you can’t control how others perceive you.

Prior to this incident, when I thought of the skills required to become a physician, I didn’t think of developing thick skin as one of them. But now, thinking back on my past year of clinical training, I realize how many times thick skin is required to continue care and keep patient-doctor relationships going.  Many of my residents had combative, uncooperative patients who stayed on their services for weeks. A patient hurled profanities and belittled one of my residents everyday for a month. She handled it professionally, treating this patient with the same compassion and respect as she did her other patients on the ward. As with any other profession, doctors interact with people from all sorts of backgrounds, with an added layer of emotional stress from illness.  The way I think of things now is that patients or their families may be frustrated by medical conditions and outcomes, causing them to react in certain ways. I try to think of people and their emotions in the context of their disease, and it helps me to understand them and their actions a little better.

It never ceases to amaze me how much I learn in the hospital aside from clinical medicine, and that’s one of the things I love about being in this field.